Chloroquine and hydroxychloroquine retinopathy-related risk factors in a Turkish cohort
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ORIGINAL PAPER
Chloroquine and hydroxychloroquine retinopathy-related risk factors in a Turkish cohort Sevil Ari Yaylali • Fariz Sadigov • Hasan Erbil Asiye Ekinci • Aylin Ardagil Akcakaya
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Received: 2 December 2012 / Accepted: 20 February 2013 / Published online: 2 March 2013 Ó Springer Science+Business Media Dordrecht 2013
Abstract To evaluate the role of previously reported risk factors on developing retinopathy in patients treated with chloroquine (CQ) and hydroxychloroquine (HCQ). Ophthalmologic examination, visual field testing, and spectral domain-optical coherence tomography were performed in 31 patients treated with CQ and HCQ. Toxicity diagnosis was proven by electrophysiological assessment. The risk factors reported by the American Academy of the Ophthalmology (AAO) were compared between patients with (n = 5) and without toxicity (n = 26) findings. Risk score was calculated for each patient. CQ daily overdose per actual body weight was significantly higher in affected patients. There was no statistically significant difference between groups concerning risk score, estimated cumulative dose of CQ, daily dose of HCQ and CQ per lean body weight, daily overdose of CQ per lean body weight and actual body weight ([3 mg/kg). The cumulative dose of HCQ was significantly higher in non-affected patients. The risk factors reported by the AAO might not be applicable to all CQ- and HCQ-treated patients. Different risk factors not yet reported may play a role in the development of CQ and HCQ retinopathy.
S. A. Yaylali (&) F. Sadigov H. Erbil A. Ekinci A. A. Akcakaya Department of Ophthalmology, Istanbul Medeniyet University Goztepe Educational and Research Hospital, Istanbul, Turkey e-mail: [email protected]
Keywords Chloroquine Hydroxychloroquine Retinopathy Risk factors Turkish cohort
Introduction Chloroquine (CQ) and hydroxychloroquine (HCQ) are used in the treatment of autoimmune diseases, specifically systemic lupus erythematosus (SLE) and rheumatoid arthritis. Although HCQ has a better safety profile, both of them can cause irreversible retinal damage [1, 2]. High daily dosage, long duration of intake, high body fat level, liver or kidney disease, concomitant retinal disease and age were established as risk factors related to CQ and HCQ retinopathy [3]. In the present study we aimed to evaluate the validity of previously reported risk factors associated with CQ and HCQ retinopathy in our cohort.
Materials and methods Thirty-one patients (29 female, 2 male) receiving CQ or HCQ treatment were included in this study. Mean follow-up time of the patients was 9.8 ± 7.09 years. All patients had normal baseline ophthalmologic examinations and were followed up annually. A full medical, weight gain or loss history and toxicity diagnosis date were documented. They underwent
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complete ophthalmologic examination, including best-corrected visual acuity, slit-lamp examination, intraocular pressure measurement and dilated fundus examination at the end of their follow-up. Visual field asse
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